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DANE COUNTY ZONING PERMIT DCPZP 2017 00591 Page1 of2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JONATHAN & ROBIN MAIER (608)43 -8647 <br /> BILLING ADDRESS(Number.Street) & ADDRESS(Number,Street) <br /> 311 COUTY HIGHWAY P <br /> (City,State,Zip) (City,State,Zip) <br /> MOUNT HOREB, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rsevedge7©gmail.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0607-041-5334-2 TOWN OF SPRINGDALE 4 NE SW <br /> PROPERTY ADDRESS HOUSE NO ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 3113 COUNTY HIGHWAY P <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 4 1 PINE BLUFF STATION (FORMERLY KLEVENVILLE) <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-3A Residence 0.44 Description:change of use-duplex 103 - Duplex <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> iii otner Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO VARIANCE NO DEED RESTRICTION <br /> B-County Highway 8491 ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES 0 NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 0 Sq.Ft Sq.Ft. 0 <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $50.00 <br /> 0 Sq.Ft. Sq Ft. PERMIT FEE <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Ow. -r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or is , __-.- <br /> plans submitted will invalidate the permit. 1.411 AWL.- 1 C / ) <br /> OFFICE USE ONLY (form version 03.01.01) <br /> SURVEY REQUIRED? DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 09/07/2017 SSA1 <br /> ❑St* ® NO DATE REVIEWED INITIALS ,/ 2nd INSPECTION DATE INITIALS <br /> Initials: 7 S' \ - /j ^ / '( iY <br />